Diagnoses and ordering practices driving blood demand for treatment of anemia in Tanzania

Apata, Ibironke W.; Drammeh, Bakary; De, Anindya K.; Bjork, Adam; Pathak, Sonal; Lyimo, Magdalena; Juma, Abdu; Kutaga, Regina; Mahmoud, Mwanakheir; Nkya, Efesper; Kuehnert, Matthew J.; Marfin, Anthony A.

doi:10.1111/trf.14461

Cited by 13 publications

(15 citation statements)

References 37 publications

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“…However, adherence to the guidelines is variable [ 11 ]. Blood transfusions are often given without laboratory confirmation of Hb level [ 12 ] or documented indications [ 13 ], and patients with indications for transfusions are not given blood [ 14 ]. Most of the studies that examined clinical use of blood amongst children have done so in children with a known pre-transfusion Hb level [ 4 , 6 , 15 ] usually under controlled research settings [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

High rate of inappropriate blood transfusions in the management of children with severe anemia in Ugandan hospitals

Opoka

Ssemata

Oyang

et al. 2018

BMC Health Serv Res

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BackgroundSevere anaemia (SA) is a common reason for hospitalisation of children in sub-Saharan Africa but the extent to which blood transfusion is used appropriately in the management of severe anemia has hitherto remained unknown. We report on the use of blood transfusion in the management of anemic children in two hospitals in Uganda.MethodsInpatient records of children 0–5 years of age admitted to Lira and Jinja regional referral hospitals in Uganda were reviewed for children admitted on selected days between June 2016 and May 2017. Data was extracted on the results, if any, of pre-transfusion hemoglobin (Hb) level, whether or not a blood transfusion was given and inpatient outcome for all children with a diagnosis of ‘severe anemia’. Qualitative data was also collected from health workers to explain the reasons for the clinical practices at the two hospitals.ResultsOverall, 574/2275 (25.2%) of the children admitted in the two hospitals were assigned a diagnosis of SA. However 551 (95.9%) of children assigned a diagnosis of SA received a blood transfusion, accounting for 551/560 (98.4%) of the blood transfusions in the pediatric wards. Of the blood transfusions in SA children, only 245 (44.5%) was given appropriately per criteria (Pre-transfusion Hb ≤ 6 g/dL), while 306 (55.5%) was given inappropriately; (pre-transfusion Hb not done, n = 216, or when a transfusion is not indicated [Hb > 6.0 g/dl], n = 90). SA children transfused appropriately per Hb criteria had lower inpatient mortality compared to those transfused inappropriately, (7 (2.9%) vs. 22 (7.2%), [OR 0.4, 95% CI 0.16, 0.90]). Major issues identified by health workers as affecting use of blood transfusion included late presentation of SA children to hospital and unreliable availability of equipment for measurement of Hb.ConclusionMore than half the blood transfusions given in the management of anemic children admitted to Lira and Jinja hospitals was given inappropriately either without pre-transfusion Hb testing or when not indicated. Verification of Hb level by laboratory testing and training of health workers to adhere to transfusion guidelines could result in a substantial decrease in inappropriate blood transfusion in Ugandan hospitals.

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Section: Introductionmentioning

confidence: 99%

High rate of inappropriate blood transfusions in the management of children with severe anemia in Ugandan hospitals

Opoka

Ssemata

Oyang

et al. 2018

BMC Health Serv Res

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“…Major etiologies related to OH included all types of abortion (68%) and ectopic pregnancy (27%); the number of recorded etiologies exceeded the number of women designated as having OH. Hemorrhage etiologies were associated with gestational (26) 15 (12) 24 (13) 28 (20) 39 (87) 75 (29) 17 (15) No 43 (12) 18 (15) 20 (16) 5 (4) 17 (9) 22 (16) 4 (9) 34 ( (12) 19 (15) 21 (16) 44 (24) 6 (4) 1 (2) 31 (12) 23 (22) Anemia 29 (8) 16 (14) 7 (6) 6 (5) 5 (3) 7 (5) 17 (38) 28 (11) 1 (1) Other 43 (12) 11 (9) 19 (15) 13 (10) 19 (11) 22 (16) 2 (4) 31 (12) 12 (12) Missing 91 (25) 28 (24) 36 (29) 27 (21) 37 (21) 32 (23) 18 (40) 65 (24) 26 (25) * Eight trimester values missing. † Chi-square p values contrast the three levels shown.…”

Section: Resultsmentioning

confidence: 99%

“…While not as well formalized in low‐middle‐income countries, patient blood management strategies (including single‐unit transfusions with reassessment and/or hemoglobin measurement in the stable nonbleeding patient rather than routine double‐unit transfusions) are very relevant given pervasive challenges surrounding blood availability. Ironically, despite shortfall in provision of blood, inappropriate transfusion and overtransfusion is not uncommon, and likely stems from relatively little education in transfusion medicine, coupled with a lack of standardization of transfusion practices as reflected by nonadherence to evidence‐based guidelines . Pertinent to the obstetric population, the Network for the Advancement of Patient Blood Management, Haemostasis and Thrombosis in collaboration with the International Federation of Gynaecology and Obstetrics and the European Board and College of Obstetrics and Gynaecology have published recommendations on prenatal iron therapy that could mitigate risk of transfusion .…”

Section: Discussionmentioning

confidence: 99%

“…Ironically, despite shortfall in provision of blood, inappropriate transfusion and overtransfusion is not uncommon, 24 and likely stems from relatively little education in transfusion medicine, coupled with a lack of standardization of transfusion practices as reflected by nonadherence to evidence-based guidelines. 25 26 These and other guidelines on patient blood management were developed during or after the index study. 27 There were limitations to the study.…”

Section: Discussionmentioning

confidence: 99%

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Antenatal blood transfusion in South Africa: indications and practice in a high‐HIV‐prevalence setting

et al. 2020

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BACKGROUND Globally, data on antenatal blood transfusion practices are scarce. We sought to characterize the epidemiology of antenatal transfusion in South Africa. STUDY DESIGN AND METHODS A cross‐sectional study was conducted of women who were transfused during pregnancy (>48 hr before anticipated delivery) at two hospitals in Durban and Soweto in 2014 to 2015. Medical record data on demographics, obstetric history, anemia, HIV status, and indications for blood transfusion were abstracted. RESULTS The records on a total of 560 transfused pregnant women were evaluated; mean age was 28 years, 98% were of black African ethnicity, and 28% were HIV positive. At time of transfusion, one‐half were in the first trimester. Hemorrhage was noted in 76% of women, most of which was associated with abortion (67%) or ectopic pregnancy (27%). Most women were transfused with red blood cells (RBCs; median, 2 units); 14% of women were transfused with plasma and 2% with platelets. Median pre‐ and posttransfusion hemoglobin levels were 6.9 g/dL and 9.2 g/dL, respectively; the latter differed by hospital (8.7 g/dL vs. 9.5 g/dL; p < 0.01). Hemorrhage was associated with missing HIV status, lower gestational age, and transfusion of 3 or more RBC units (all p < 0.01). In contrast, diagnoses of anemia (Soweto only) were associated with HIV infection, later gestational age, and lower (<3 units) RBC dose (all p < 0.01). CONCLUSION Abortion and ectopic pregnancy with associated hemorrhage were the leading indications for antenatal transfusion and were concentrated in early gestation. By contrast, anemia was associated with HIV infection and transfusion in the third trimester.

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“…One study in Tanzania found that 17% of requested units were deemed inappropriate. 95 A survey of seven African countries found that none of the participating countries had any personnel who were exclusively trained in transfusion medicine, and only one had standing operational protocols. 19 The level of training among prescribers also varies greatly.…”

Section: Rational Blood Usementioning

confidence: 99%

Blood transfusion safety in sub‐Saharan Africa: A literature review of changes and challenges in the 21st century

Weimer

Tagny

Tapko³

et al. 2018

Transfusion

107

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BACKGROUND Access to a safe, adequate blood supply has proven challenging in sub‐Saharan Africa, where systemic deficiencies spanning policy, collections, testing, and posttransfusion surveillance have long been recognized. Progress in transfusion safety in the early 2000s was in large part due to intervention by the World Health Organization and other foreign governmental bodies, coupled with an influx of external funding. STUDY DESIGN AND METHODS A review of the literature was conducted to identify articles pertaining to blood safety in sub‐Saharan Africa from January 2009 to March 2018. The search was directed toward addressing the major elements of the blood safety chain, in the countries comprising the World Health Organization African region. Of 1380 articles, 531 met inclusion criteria and 136 articles were reviewed. RESULTS External support has been associated with increased recruitment of voluntary donors and expanded testing for the major transfusion‐transmitted infections (TTIs). However, the rates of TTIs among donors remain high. Regional education and training initiatives have been implemented, and a tiered accreditation process has been adopted. However, a general decline in funding for transfusion safety (2009 onwards) has strained the ability to maintain or improve transfusion‐related services. Critical areas of need include data collection and dissemination, epidemiological surveillance for TTIs, donor recruitment, quality assurance and oversight (notably laboratory testing), and hemovigilance. CONCLUSION Diminishing external support has been challenging for regional transfusion services. Critical areas of deficiency in regional blood transfusion safety remain. Nonetheless, substantive gains in education, training, and accreditation suggest durable gains in regional capacity.

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Diagnoses and ordering practices driving blood demand for treatment of anemia in Tanzania

Cited by 13 publications

References 37 publications

High rate of inappropriate blood transfusions in the management of children with severe anemia in Ugandan hospitals

High rate of inappropriate blood transfusions in the management of children with severe anemia in Ugandan hospitals

Antenatal blood transfusion in South Africa: indications and practice in a high‐HIV‐prevalence setting

Blood transfusion safety in sub‐Saharan Africa: A literature review of changes and challenges in the 21st century

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